CDE0115_30-34_Vanini 24.02.

15 15:38 Seite 1

I industry report _ direct resin restorations

Direct resin restoration using

the new V4-Ring matrix
and the new Micerium Enamel
Plus HRi Function composite
Authors_Drs Francesco Simoni & Lorenzo Vanini, Italy

Fig. 1 Fig. 2

Fig. 1_Clinical view of carious
lesion on 24 distal.
Fig. 2_X-ray view of carious
lesion on 24 distal.
Fig. 3_First access to carious lesion
on 24 distal with the protection
on 25 by matrix and wedge.
Fig. 4_Removing decay using
a medium-grained diamond bur
on a red ring hand piece.
_Introduction
In restorative dentistry, as in all dentistry fields,
in order to obtain a correct diagnosis it is essen-
tial to perform a proper clinical analysis, to take
at least bite wings X-rays or preferably full mouth
X-rays and to use a magnification system.1
Once a correct diagnosis has been obtained,
the first treatment phase is to eliminate gingival
inflammation by teaching the patient proper oral
hygiene methods, followed by simple scaling,
or complete non-surgical periodontal therapy.2
It is then possible to proceed with the removal
of the carious lesion.
This paper describes the most important steps
in performing a correct class II restoration using
the new V4-Ring matrix and the new Enamel Plus
HRi Function composite (Micerium).

Fig. 3 Fig. 4

30 I cosmetic dentistry 1_ 2015

CDE0115_30-34_Vanini 24.02.15 15:38 Seite 2
_Case study
After careful clinical and X-ray examination of
the tooth decay on the second upper left premo-
lar (Figs. 1 & 2), we carried out a local anaesthesia
with articaine 1:100,000. Before proceeding with
the removal of the carious lesion, the adjacent
tooth must be protected with a matrix and a
wedge (Fig. 3). The access to the cavity is then
provided and a rubber dam is placed. Once the
operative field has been isolated, the decay is re-
moved first by using a medium-grained diamond
ENAMEL HRi®
Function
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ENAMEL PLUS HRI FUNCTION IN DENTAL OFFICE
ENAMEL PLUS HRI FUNCTION IN LABORATORY
industry report _ direct resin restorations I
Fig. 5 Fig. 6
bur mounted on a red ring hand piece (Fig.4) and Fig. 5_Removing decay using a
then a round (rosette) bur on a blue ring hand rosette bur on a blue ring hand piece.
piece (Fig. 5). The preparation of the cavity is Fig. 6_Finishing using a fine-grained
finished with a fine-grained diamond bur on a red diamond bur on a red ring hand piece.
ring hand piece (Fig. 6) and with a red rubber on
a blue ring hand piece (Fig.7). In order to optimise
the preparation of the cavity at the marginal level
metal strips are first used (Fig. 8) followed by
paper strips (Fig. 9).
Once the preparation is finished the matrix
V-Ring 4 is placed (Figs. 10 & 11) using the pin
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Enamel-composite system subject to low abrasion that is comparable to natural

enamel. Ideal for use in posterior areas with direct or indirect technique and especially
to restore the function in a micro-invasive way respecting the neuromuscular system
and getting an excellent aesthetic integration.
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ENAMEL HRI FUNCTION = NATURAL ENAMEL = WEAR = AESTHETICS = UNIQUE!

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CDE0115_30-34_Vanini 24.02.15 15:38 Seite 3
I industry report _ direct resin restorations
Fig. 7
Fig. 9
Fig. 7_Polishing enamel with a
rubber red on a blue ring hand piece.
Fig. 8_To optimise cavity preparation at
the marginal level, metal strips are used.
Fig. 9_To optimise cavity
preparation at the marginal level,
paper strips are used.
Fig. 10_Cavity preparation is completed.
Fig. 11_Once the preparation
is finished matrix V-Ring 4 is placed
with its proper tweezers, which are
placed in the little hole on the matrix,
making its insertion easier.
Fig. 11
32 I cosmetic dentistry 1_ 2015
Fig. 8
Fig. 10
tweezers, which are placed in the hole on the
matrix itself making insertion easier (Fig. 11).
After checking proper assembly, the wedge and
the transparent tines of the V4-Ring are inserted
(Figs. 12–15). This allows light to pass through for
360° polymerisation.
After the matrix has been positioned, ENAetch
is applied for 30 seconds evenly with a brush to
distribute the etching agent (Figs. 16 & 17), and
the area is washed with water for 30 seconds and
with 0.2 % chlorhexidine digluconate (Fig.18).3
Ena Bond is then applied for 60 seconds (Fig.19).
Fig. 12
It must be polymerised for 40 seconds4 (Fig. 20) and
at the end ENAseal is brushed on for 30 seconds
(Figs. 21–22).5 Finally the cavity is polymerised
again for 40 seconds (Fig. 23).6
Every step has to be done properly, from
carious lesion removal to cavity surface fin-
ishing. Any approximation may compromise
long-term outcome and restoration aesthetics.7
With adhesive techniques it is mandatory to
respect all protocols in order to prevent sec-
ondary tooth decay and ensure a long lasting
restoration.8
CDE0115_30-34_Vanini 24.02.15 15:38 Seite 4
Fig. 13
Once the adhesive step is finished, the inter-
proximal wall is built up9 with Enamel Function 2
(Fig. 24) and finally, due to the new V4-Ring
matrix special design, it is possible to polymerise
the buccal, palatal and occlusal aspect of the
composite reconstruction.
Once the restoration has been completed with
Enamel Plus HRi Dentine UD3 and Enamel Plus
HRi Function EF2, the fissures are characterised
with Stain brown 2 and the marginal ridge with
Intensive White.10, 11
After modelling, the restoration is finished
on the interproximal level with paper strips.
An occlusal check (Fig. 25), X-ray control (Fig. 26),
and careful polishing are mandatory. A well-
industry report _ direct resin restorations I
Fig. 14 Fig. 15
Fig. 16 Fig. 17
polished restoration is less likely to attract plaque Fig. 12_After checking the proper
adhesion, and is more respectful of periodontal assembly of the wedge and the
tissues, while also maintaining better aesthetics transparent ring of V-Ring 4 are inserted.
over time (Fig. 27).3–12_ Fig. 13_The transparent ring
of V-Ring 4.
_References Fig. 14_V-Ring 4, note light passing
through the matrix.
1. Ricci G. Chapter 1 Diagnosis from the book “Perio- Fig. 15_The wedge
dontal Diagnosis and Therapy” Quintessence 2012. of the transparent V-Ring 4.
2. Ricci G. Chapter 2 Non Surgical Periodontal Therapy Fig. 16_ENAetch, Micerium.
from the book “Periodontal Diagnosis and Therapy” Fig. 17_Etching for 30 seconds
Quintessence 2012. with ENAetch, a brush is used
3. Breschi L, Cammelli F, Visintini E, Mazzoni A, Vita F, to evenly distribute etching.
Carrilho M. Influence of chlorhexidine concen- Fig. 18_Washing with water
tration on the durability of etch and rinse dentin for 30 seconds and with
bonds: a 12-month in vitro study. J Adhes Dent 0.2% chlorhexidine digluconate.
2008. Fig. 19_ENAbond for 60 seconds.
Fig. 18 Fig. 19
cosmetic
dentistry 1 _ 2015 I 33
CDE0115_30-34_Vanini 24.02.15 15:38 Seite 5
I industry report _ direct resin restorations
Fig. 20
Fig. 23
Fig. 26
Fig. 20_Polymerisation
for 40 seconds.
Fig. 21_ENAseal for 30 seconds.
Fig. 22_ENAbond
and ENAseal, Micerium.
Fig. 23_Polymerisation
for 40 seconds.
Fig. 24_Enamel Plus HRi
Function 2 Micerium.
Fig. 25_An occlusional check.
Fig. 26_An X-ray check, note the
maximum integration of restoration.
Fig. 27_Occlusal view of restoration.
34 I cosmetic dentistry 1_ 2015
Fig. 21 Fig. 22
Fig. 24 Fig. 25
Fig. 27
4. Vanini L.from the book “Conservative restoration 10. Vanini L. from the book “Conservative restoration of
of anterior teeth” Chapter 3.8 Composites and ad- anterior teeth” Chapter 4.9 The layering tecnique:
hesion: polymerization. ACME 2003. costruction of “intensive” ACME 2003.
5. D’Arcangelo C, Vanini L et al. The clinical influence 11. Vanini L. from the book “Conservative restoration
of adhesive thickness on the microtensile bond of anterior teeth” Chapter 4.11 Anatomic layerying
strength of three adhesive systems J Adhes Dent. tecnique: construction of the characterizations
2009 Apr;11(2):109–15. ACME 2003.
6. Van Meerbeek B, De Munk J, Yoshida Y, Inoue S, 12. Vanini L. from the book “Conservative restoration
Vargas M, Vijay P et al. Buonocore memorial lecture. of anterior teeth” Chapter 7.3 Aesthetic and gin-
Adhesion to enamel and dentin: current status and gival architecture: gingival contour and adhesive
future challenges. Oper Dent 2003; 28: 215–235. restorations. ACME 2003.
7. Vanini L. from the book “Conservative restoration
of anterior teeth” Chapter 5.5 The Shape in conser-
vative restoration: finishing, polishing and buffing
of the conservative restoration” ACME 2003. _contact cosmetic
dentistry
8. Drummond JL. Degradation, fatigue, and failure of
resin dental composite materials. J Dent Res. 2008 MICERIUM S.p.A.
Aug; 87(8): 710–719. Via Marconi, 83
9. Magne P., Dietschi D., Holz J. Esthetic restorations 16036 Avegno, Italy
for posterior teeth: pratical and clinical considera-
tions. Int J Periodontics Restorative Dent 1996; www.micerium.com
2:105–119.